Imagine you are in downtown Toronto. You are a young energetic 20-year old
college kid. No kids to worry about, you are just enjoying your youth and
having fun. You are going to see a Beetles concert with two of your closest
friends and are just waiting for a streetcar to get onto to take you to
where you need to go. People have been talking about this concert for weeks
now and you and your friends are super excited to finally get to see the
big show. Up ‘til now you guys have travelled by bus, subway and taxi to
get from your urban homes to the point where are you are at now.

Now imagine that you live in a small rural village in South Africa where
your community is very much family-oriented. Everyone gathers their own
food to feed their families. On many days you see your neighbour’s two
small children running around with a ball in their hands. Their faces
glowing with laughter and smiles as they play in the dirt track that
crosses your little shack home that’s made from tree branches with those of
your neighbours. Sometimes, your neighbours might supply you with their
favourite dish just as a nice gesture. The village itself lies several
kilometers through the bush with no electricity, no telephone and no
running water.

You are a poor South African 35-year old woman who already has 10 children
you need to support. You work on the land that surrounds you: gathering
maze you planted in early spring, digging deep into the soil to extract the
nutritious roots and vegetables that are part of your diet, you squeeze
your cow every morning so she can provide your children their daily milk
intake. You work hard every day from dawn ‘til dusk, every day of your life
to support those children. But, what if you fall ill with a serious
disease, such as malaria or HIV? The nearest clinic is 20 kilometers away
by wagon and isn’t even fully equipped to treat your disease. And the
nearest major hospital that does have the capacity to treat you is another
30 kilometers away. Now what?

ICT or information and communication technology is a growing trend in
developed countries, such as Canada and the U.S. However, in some fields,
such as in healthcare we aren’t the only ones who can benefit from it.
Telemedicine has been around for almost 40 years, first in the form of
experimental programs to see how it works communicating with patients from
different hospitals then being installed permanently in some North American
hospitals. Now it’s gone global, but still relatively few people know about
this technology within general society and even within the scholarly
community itself. So, what exactly is telemedicine anyway?

According to the American Telemedicine Association, “telemedicine is the
use of medical information exchanged from one site to another via
electronic communications to improve a patient’s clinical health status.”
In simpler terms telemedicine is the use of video conferencing to connect
with patients at a distance. Telemedicine also ranges in its capabilities
to help people in different parts of the country and in different parts of
the world. The spectrum ranges from simple video consultations through
two-way video with the doctor-at-hand to “virtual hospitals” offering a
full range of home care for HIV patients

Telemedicine allows for South Africans who are living out of reach of major
hospitals in poorer areas and suffering from HIV/ AIDS to get treated by
connecting qualified North American doctors with South African hospitals
and their patients. Physicians are able to build up their knowledge of the
patient, treat them more confidentially, and make fewer referrals by video
conferencing because telemedicine enables doctors to connect with HIV
specialists as well as the patients themselves simultaneously. Telemedicine
has also been proven to be cost effective by reducing travel times,
allowing HIV positive patients to interact with North American doctors from
the comfort of their own homes instead of being hospitalized, and studies
have shown that telemedicine provides the same or higher quality healthcare
than traditional hospitalizations.

Despite these pluses in incorporating telemedicine as part of the
healthcare system, South Africa has been slow in implementing the ICT into
its system. Why is this? We as citizens in the developed world may take
even the simplest things for granted forgetting that millions of people
worldwide sometimes don’t have enough food to feed their families, never
mind having ICT advancements put in place by their government for ordinary
people to use. An academic research study called ICT applications as
e-health solutions in rural healthcare in the Eastern Cape Province of
South Africa both confirmed this seemingly obvious fact and added more
reasons to why healthcare in South Africa hasn’t caught on with the
developed world.

The results from this 2010 research study indicate that the local economy
has been compromised by the lack of infrastructure, services and expertise;
this includes lacking specialization in the ICT industry. Interestingly,
the study also found that there may be psychological barriers stopping
South African practitioners from using telemedicine. The psychological
barriers come under one umbrella term known as the Technology Acceptance
Model (TAM). TAM then branches out in two ways. One is the perceived
usefulness of the technology or “the extent to which a person believes this
particular technology will benefit or enhance job performance”. The second
barrier is the perceived ease of using the technology. Is it too
complicated to use frequently? Another issue is geographic location where
most South African reside in rural areas where rural hospitals/ clinics are
the ones struggling to connect with ICT.

A study of 56 South African participants in five healthcare centers
throughout Eastern Cape were put three categories 1) the hospital managers
2) staff (doctor, nurses, administrators) 3) the hospital inpatients at the
time of the survey. The results show that:

Hospital #1: had telemedical equipment and internet capabilities, but very
few computer which limits the realization of benefits to ICT.

Hospital# 2: technology is slightly better, but still limited.

Hospital# 3: had decent--quality ICT, however, they weren’t available in
all hospital departments. The ICT is widely distributed.

Hospital# 4: had computers for telemedicine, but due to unreliable internet
sometimes the ICT worked, other times it did not.

Hospital# 5: has ICT technology, but again internet connection is
unreliable.

As you can see overall the study confirmed that ICT use in the Eastern Cape
region of South African was weak due to the unreliability of the Internet.
This data can be expected from a nation that is so new to ICT industry and
has a history of being at a disadvantage economically.

In my own primary data collection I asked 15 people eight questions about
what their experiences were using Skype, their thoughts on Skype technology
being used in the healthcare industry, and on any negatives to use in terms
of language barriers and/or any issues directly associated with the ICT
itself.

These are my results. When I asked the question, “Do you see any setbacks
to using Skype when re-connecting with loved ones? 13 out of the 15 people
questioned answered a firm “yes”. When asked to be more specific and say
what kind of troubles they had when using Skype many of them said the
trouble starts when Skype freezes up mid conversation, there is poor
internet connection similar to the issues present in the Eastern Cape
study, or the camera completely blanked out.

Similarly, when I asked “Do you foresee any drawbacks with telemedicine
technology?” since Skype and telemedicine share the same video conferencing
system my respondents had similar replies with an additional language
barrier issue.

When I asked how can we” fix” the language barrier problem many replied
that there should an interpreter standing with the North American doctor or
the South African practitioner and the patient and who translate between
the patient and the American doctor. Yes, getting a interpreter may be the
first thing people think of when there is a language barrier involved.
However, what people don’t realize the cost of hiring an interpreter and
the relative difficulty of finding one that knows those two languages. This
is especially true for South Africa where each community may speak a
different language or dialectic from the one neighboring it.

The second most popular response I got from asking this question was having
a diverse group of medical professionals that speak many languages. This is
also a problem because most South African practitioners don’t even know as
much in their medical specialization as do their North American
counterparts. A South African doctor that knows multiple languages is a
rarity because of the education levels associated with such a poor country
as South Africa. On the other side of the telemedical screen North American
doctors don’t know any African dialect to be able to communicate with their
South African patients unless they have some African ancestors in their
family lineage.

One solution to the problem is to get a translator installed right into the
video conferencing software. Skype recently invented a translation system
that is an add-on to the overall Skype experience. Presently, the app can
translate speech in six languages: English, German, French, Italian,
Mandarin and Spanish. Skype is planning to introduce even more languages in
the near future, but how it works is if two people are talking through
Skype but both only speak in their native tongues (perhaps one person only
speaks English and the other knows only his native Italian) the app will
automatically translate the other person’s conversation as that person
speaks. In this way, both of them have no trouble understanding each other
despite knowing not one word of the other person’s language. This same kind
of translating app can be installed in telemedical technology when more
languages are released to help the South African patients and their North
American doctors understand each other. This would also get rid of the
possibility that the patients didn’t take the right prescription or totally
wrong drug than the one the doctor prescribed just because s/he
misunderstood the doctor’s instructions. Telemedicine is the future of
medicine, although there is much that still needs to be improved in South
Africa’s acceptance and use of ICT in the healthcare industry.